RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-02776
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060526

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an National Guard E4, Health Care Specialist, medically separated for “major depressive disorder and panic disorder” with a disability rating of 10%.

CI CONTENTION:  The CI requested consideration of all conditions. The CI’s complete submission is at Exhibit A. 

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060413	VARD - 20061220	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Major Depressive Disorder and Panic Disorder	9434-9412	10%	Major Depressive Disorder and Panic Disorder	9412-9434	30%	20060303	
Occasional Plantar Fasciitis	Not Unfitting	Degenerative Joint Disease, Plantar Fasciitis, Left Foot	5010-5310	10%	20061206	
		Degenerative Joint Disease, Plantar Fasciitis, Right Foot	5010-5310	10%	20061206	
Dyslipidemia	Not Unfitting 	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  60%	

ANALYSIS SUMMARY:    

MDD and Panic Disorder.  The Medical Evaluation Board (MEB) forwarded two mental health (MH) conditions, major depressive disorder (MDD) and panic disorder without agoraphobia, as not meeting retention standards to the PEB for adjudication.  However, in accordance with VASRD guidelines for rating MH impairment, only a single disability rating is provided for MH conditions based on total social and occupational functioning (with the exception of eating disorders) IAW VASRD §4.130 (mental disorders).  Therefore both MH conditions are discussed together.

According to the service treatment records, MEB narrative summary (NARSUM) and the MEB Psychology NARSUM, the CI’s MH condition began during a deployment in December 2003.  She was referred for MH evaluation in January 2004 and participated in an anger management course.  She reported there were morale issues within the unit.  She reported that when she returned to her unit things were initially better and she completed the tour.  Upon return from deployment, she reported intermittent symptoms of panic and anxiety between August 2004 and January 2005, exacerbated by stressors including starting school, moving, and then starting to drill again.  In January 2005 she reported suicidal ideation (SI), without any plans or suicide attempts.  She reported waking up crying and not knowing why.  At a required MH evaluation in August 2005, the CI reported panic symptoms and depression symptoms precipitated by major life events.  She reported decreased concentration and memory, and that she continued to isolate herself.  She reported avoiding anything to do with the military, including the news.  The mental status examination (MSE) was normal, the CI denied SI.  The Axis I diagnoses were mild, recurrent MDD and panic disorder without agoraphobia and the Global Assessment of Functioning (GAF) was 55 (moderate impairment range 51-60).  The CI was evaluated at the VA in November 2005 and the VA examiner diagnosed panic disorder and MDD, but noted that no Criterion A stressor had been identified for a diagnosis of posttraumatic stress disorder (PTSD).  The CI was treated with antidepressant medications (trazadone and Zoloft) and was told she only needed to be seen for medications.  Despite treatment, the MH condition could not be adequately rehabilitated to meet the requirements of the CI’s military specialty and the CI was referred for MEB.  The MEB forwarded “major depressive disorder” and “panic disorder without agoraphobia” for PEB adjudication.  

The commander’s statement dated 10 January 2006 noted that stress and anxiety and bouts of depression “severely” inhibited the CI’s ability to perform her duties in “either a field or garrison environment.”  The permanent profile dated 16 March 2006 listed MDD and panic disorder without agoraphobia.  

At the MEB NARSUM examination on 14 March 2006, 2 months prior to separation, the CI reported minimal symptoms of withdrawal and anxiety/panic symptoms about 1 or 2 times per week lasting for approximately 20 minutes, that had improved “50%.”  She was sleeping well and denied any SI.  She reported tolerating her antidepressant medications well without side effects.  There was no MSE performed.  

At the VA Compensation and Pension (C&P) examination on 3 March 2006, 3 months before separation, the CI reported nightmares about her experiences during deployment, without flashbacks, intrusive recollections, physical reactivity, or psychological distress.  The CI was able to talk about her experiences although she reported avoiding members of her unit.  She had no amnesia for events.  She reported isolating herself, but no emotional numbing or sense of a foreshortened future.  The CI reported panic attacks that came on quickly and dissipated in about 5 minutes, 4 to 6 times per month.  She reported they were “better” since she was on antidepressant medication.  She reported her depression was also better because she was sleeping better and had regained some interest.  She was able to concentrate effectively, but still had some decreased energy and difficulty initiating activity.  She reported some guilt, which was deemed not to be excessive.  The CI was employed caring for a disabled individual and had not lost any work time.  The MSE was normal, and the examiner noted "her mood is one of reasonable optimism.”  The Axis I diagnoses remained the same and the GAF was “62 indicating mild symptoms.”  Regarding the CI’s occupational and social functioning, the VA psychiatrist stated “in her work functioning, she experiences difficulty with efficiency, productivity, reliability, and performing work tasks only during periods of stress and the severity is only mild or transient.  She occasionally has difficulty in relationships and that is mild and transient.”  Psychological testing was requested for diagnostic clarification.  An addendum dated 4 March 2006 indicated that psychological testing had been completed, but was not valid and could not be used for the assessment.  The VA psychiatrist further noted that the diagnoses of MDD and panic disorder without agoraphobia were consistent with the CI’s functioning and concluded by noting that the CI’s condition had been helped significantly by treatment, but she continued to have mild symptoms.  The psychiatrist related the CI’s remaining functional difficulties to her depression symptoms of decreased concentration and difficulty initiating actions and noted the panic symptoms “have not caused significant contraction in her ability to function fully.”

The Board directed attention to its rating recommendation based on the above evidence.  The PEB assigned a 10% rating, coded 9434-8412 (MDD-Panic disorder) citing mild industrial impairment.  The VA rated the MH condition 30%, coded 9412-9434, citing occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks.  

The Board first considered if application of VASRD §4.129 (Mental disorders due to traumatic stress) was applicable in this case, which states that when a MH condition that develops in service as a result of a highly stressful event is severe enough to result in the service member’s release from active military service, a rating of 50% shall be assigned for a period of six months, followed by a re-evaluation at the time.  Member consensus was that there was no evidence in record of a highly stressful event consistent with the meaning and purpose of §4.129; thus, application of §4.129 was not warranted in this case.  The Board next turned to deliberation of a rating recommendation for the MH condition at the time of separation.

The Board engaged in lengthy deliberations between the 10% and 30% ratings criteria.  Although the VA assigned a 30% rating, at the VA C&P examination, which in this case was a pre-separation examination in close proximity to the date of separation, the psychiatrist indicated that the CI was improved with medication treatment and used the language of the 10% rating to describe the CI’s level of functioning - “occupational and social impairment due to mild or transient symptoms which decrease work efficiency only during periods of significant stress, or; symptoms controlled by continuous medication.”  The CI was noted to be employed in a flexible, but full time capacity and reported she had not lost any work time.  At the MEB NARSUM examination two weeks after the C&P examination, the CI continued to report she was doing well, with minimal symptoms of depression and short duration anxiety/panic attacks which occurred once or twice per week.  The Board minority suggested that the persistent panic attacks provided support for the 30% rating.  However, the Board majority acknowledged that the panic attacks were persistent, but noted they were improving on medication and judged they were accurately described as “controlled on continuous medication.”  Thus, the Board consensus was that the evidence in record supports that following treatment, proximate to separation, the CI’s occupational and social impairment was consistent with a 10% rating as adjudicated by the PEB.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board majority concluded that there was insufficient cause to recommend a change in the PEB adjudication for the MH condition.  

Contended PEB Conditions.  The Board’s main charge is to assess the fairness of the PEB’s determination that the contended dyslipidemia and “occasional plantar fasciitis” conditions were not unfitting.  The bilateral PF was not listed on the permanent profile.  However, records indicate the CI had previously been placed on a permanent L2 profile.  A “2” profile designation indicates a condition that requires some physical limitations, but is not in all cases disqualifying for continued military service.  The dyslipidemia was not profiled.  Neither the dyslipidemia nor the PF conditions was implicated in the commander’s statement and they were not judged to fail retention standards.  All were reviewed and considered by the Board.  There was no performance-based evidence from the record these conditions significantly interfered with satisfactory duty performance at separation.  After due deliberation, and in consideration of the preponderance of the evidence, the Board concluded that there was insufficient cause to recommend a change in the PEB fitness determination for the dyslipidemia or PF conditions and so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the “major depressive disorder and panic disorder without agoraphobia” condition and IAW VASRD §4.130, the Board majority recommends no change in the PEB adjudication.  In the matter of the contended dyslipidemia and “occasional plantar fasciitis” conditions, the Board unanimously recommends no change from the PEB determinations as not unfitting.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140604, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for AR20160010990 (PD201402776)

I have reviewed the enclosed Department of Defense Physical Disability Board of
Review (DoD PDBR) recommendation and record of proceedings pertaining to the
subject individual. Under the authority of Title 10, United States Code, section 1554a,
I accept the Board's recommendation and hereby deny the individual's application.

This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA